I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them.--Thomas Jefferson

Saturday, March 5, 2011

Health Care: The Best Plan is to Have No Plan.

 In response to the Obamacare health plan, groups from doctors to union bosses to Republicans (not in any particular order) have put forth their alternative plans.  Today, there are more plans floating around D.C.  than those we used to win World War II.  (And at least the military readily admits that war plans don’t survive the first armed encounter.) No, we do not need any more plans.  The best plan, is to have no plan.  None.  Because plans require planners, and if the Twentieth Century should have taught us anything it is that central planning doesn’t work.

We have the cheapest most abundant available food in the world.  As Dinesh D’Souza once said of his brother. “He wanted to move to America, because he wanted to come to a place where even the poor people were fat.”  We are blessed with this plenty because we have no “Food Delivery System”—no plan.  Our food comes to us courtesy of independent farmers and grocers and truckers and middlemen, who, acting in their own financial self interest, grow and market a plethora of food.  I’m not always happy about food additives, or the appearance on the low shelves of some sugar bomb placed at my children’s eye level, but I have nearly infinite choices, and the freedom to avoid the foods I don’t want.

Thinking again of our food supply, imagine a different world in which prices are determined by the central planners, and you are given ration cards for basic staples.  Anything above and beyond your subsistence ration and you have to apply to the food politburo for special consideration, or you have to be “connected”. There are long lines for quality products, and grocers are periodically sent to jail for abusing the system. That describes the former Soviet food system, and our current “system” of government regulated partially privatized medicine.

There is very little left of a free market in medicine.  Most medical care, even if not directly paid for by the government (60% of all medical care is) is regulated by the 150,000 plus pages of Medicare rules that carry the force of law.  A cash paying person cannot be charged below Medicare rates because that would be discriminatory against Medicare patients.  Hospitals must be certified by Medicare reviewers who may threaten to shut down the facility over failure of paperwork.  My former large emergency hospital—the only one in a 180 mile radius—was threatened with decertification because male patients were being transferred without written affirmation that they were not pregnant.  (You really can’t make this stuff up.)  Doctors are cowed into cringing subservience by the Stalinist tactic of selective secret prosecution.   Medicare commissions purport to be recouping “excessive charges”, but they hit the unsuspecting doctor with a mountain of paperwork, perform a limited audit then multiply the supposed error by three, add a huge penalty and threaten him with long jail time unless he just coughs up a huge sum of money.  And he is to keep quiet. 

There are pockets of free enterprise in Medicine which are doing well in keeping cost down and quality high.  Lasik—the procedure to correct vision—is not covered by Medicare or insurance.  It once cost $5000 but now can be had for $500 or less.  The same highly trained physicians using highly technical equipment, have responded to competition by reducing costs.  And it is readily available.  Medicare patients may wait three months to see a Rheumatologist, Orthopaedist or other specialist who takes Medicare, but they can get their cash Plastic Surgery or Lasik tomorrow!  There are growing cash practices among primary care doctors who provide quick access, and unhurried medical visits.  Anti-aging physicians who specialize in individualized treatment protocols based on sophisticated testing are able to negotiate reduced lab costs by paying cash, and offer long thorough evaluations unheard of in government payment schemes. 

So lets not have any more plans.  We started centrally planning Medicine in 1965, and it has been downhill ever since. Government programs, whether Medicare or its ugly oppressive descendant Obamacare, cannot exist without codifying, tallying, supervising, and in general creating tons of paperwork.  This is intrinsic to bureaucracy, but inhibitory to quality, efficient, effective medical care between a doctor and a patient.  Who doesn’t yearn for medicine in the age of Marcus Welby, that icon of the kind family doctor who always knew what to do in any situation.  He epitomizes an era when doctors treated patients without having to consult the rulebooks, the billing CPT codebooks, and without wasting time protecting themselves by dictating a three-page note for a five-minute visit.  Medicine, like groceries, is a necessity, but also a commodity which behaves economically like any other commodity.  Central planning has produced starvation everywhere it was applied to food, and it produces substandard health care and death when applied to medicine.  So when it comes from the government, no plan is always the best plan.

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